| NPI | 1023308392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMY WASFY YOUSEF BOULOS Dentist (Dds) 952-465-7210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 12329) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-07 |